Determinants of

Learing
Title Slide 2
Objectives:
At the end of the 3 hours lecture -discussion, the learner will:

1. Understand the role of the nurse as an educator.

2. Identify methods of assessing the learner.

3. Determine cues for readiness to learn.

4. Enumerate various learning styles, methods and instruments.

The Educator’s Role in Learning

• One of the most essential interventions that a nurse performs

• The learner— not the teacher—is the single most important

person in the education process

• Educators can greatly enhance learning when they serve as

facilitators helping the learner become aware of what needs to
be known, why knowing is valuable, and how to be actively
involved in acquiring information.
The educator plays a crucial role in the learning process by doing
the following:

• Assessing problems or def icits and learners’ abilities

• Providing impor tant best evidence information and presenting it in unique and
appropriate way

• Identifying progress being made

• Giving feedback and follow-up

• Reinforcing learning in the acquisition of new knowledge, skills, and attitudes

• Determining the ef fectiveness of education provided

Assessment of the Learner

• The first and most important step in instructional design

• Evidence suggests, however, that individualizing teaching based

on prior assessment improves patient outcomes.

For example, Corbett’s (2003) research demonstrates that

providing individualized education to home care Assessment of
the Learner 121 patients with diabetes significantly improves
their foot care practices.
• This initial step in the process validates the need for learning and the
approaches to be used in designing learning experience.

• Assessment prevents needless repetition of known material, saves

time and energy on the part of both the learner and the educator.

• The nurse in the role of educator must become better acquainted and
comfortable with all the elements of instructional design, particularly
with the assessment phase because it serves as the foundation for the
rest of the educational process.
Assessment of the learner includes attending to the three
determinants of learning (Haggard, 1989):

1. Learning needs—what the learner needs and wants to learn.

2. Readiness to learn—when the learner is receptive to learning.

3. Learning style—how the learner best learns

Assessing Learning Needs

Learning needs are defined as gaps in knowledge that exist

between a desired level of performance and the actual level of
performance (HealthCare Education Associates, 1989).

In other words, a learning need is the gap between what

someone knows and what someone needs or wants to know.

Such gaps may arise because of a lack of knowledge, attitude, or

skill.
Learning Needs

• Nurse educators must identify learning needs first so that they

can design an instructional plan to address any deficits in the
cognitive, affective, or psychomotor domains.

• Not every individual perceives a need for education. Often,

learners are unaware of what they do not know or want to
know. Consequently, it is up to the educator to assist learners in
identifying, clarifying, and prioritizing their needs and interests.
Steps in Assessment of Learning Needs

1. Identify the learner. 7. Determine availability of

educational resources.
2. Choose the right setting
8. Assess the demands of the
3. Collect data about the learner.
organization.
4. Collect data from the learner.
9. Take time-management issues
5. Involve members of the into account.
healthcare team

6. Prioritize needs
Methods to assess the learning needs
Objective data vs Subjetive data

Informal Conversations-impromptu conversations

Structured Interviews-direct and often predetermined questions

Take notes with the learner’s permission so that important

information is not lost. The telephone is a good tool to use for an
interview if it is impossible to ask questions in person. The major
drawback of a telephone interview is the inability on the part of the
nurse educator to perceive nonverbal cues from the learner.
Focus Groups

Focus groups involve getting together a small number (4 to 12)

of potential learners (Breitrose, 1988; Duke University, 2005) to
determine areas of educational need by using group discussion to
identify points of view or knowledge about a certain topic.

-open-ended questions

-safe environment
Questionnaires

-Written responses to questions about learning needs

-Checklists are one of the most common forms of questionnaires

-Easy to administer, provide more privacy compared to interviews, and

yield easy-to-tabulate data

-Patient Learning Needs Scale (Redman, 2003)

-This instrument is designed to measure patients’ perceptions of

learning needs to manage their health care at home following a medical
illness or surgical procedure ( Bubela et al., 2000)
Tests

-pretests

-prevents the educator from repeating already known

material in the teaching plan

-pretest scores are compared with posttest scores to

determine to what extent learning has taken place

-Diabetes Knowledge Test

Observations

Observing health behaviors in several different time periods

can help the educator draw conclusions about established
patterns of behavior that cannot and should not be drawn from a
single observation.

Documentation

Initial assessments, progress notes, nursing care plans,

staff notes, and discharge planning forms can provide information
about the learning needs of patients
Readiness to Learn

Readiness to learn can be defined as the time when the learner

demonstrates an interest in learning the information necessary to
maintain optimal health or to become more skillful in a job.

Readiness to learn occurs when the learner is receptive, willing, and

able to participate in the learning process.

No matter how important the information is or how much the educator

feels the recipient of teaching needs the information, if the learner is
not ready, then the information will not be absorbed.
 Before teaching can begin, the educator must find the time
to first take a PEEK (Lichtenthal, 1990) at the four types of
readiness to learn—physical readiness, emotional readiness,
experiential readiness, and knowledge readiness. These four types
may either be obstacles or enhancers to learning.
Physical Readiness
5 m a j o r co m p o n e n t s

1 . Me a s u res o f Ab i l i t y

• A b i lity to p e r f o r m a ta s k r e q u i re s f i n e a n d / o r g r o s s m o to r m ove m en ts , s e n s o r y a cu i ty,

a d e q u a te s tr e n g th, f l e xibility, co or din atio n , a n d e n d u ra n ce.

• E x. wa l k in g o n cr u tch e s - p hys ical a bility, a s p i r o m eter -vis u al d e f i cit , lif ting a n d

tra n s f e r a ctivitie s -e nd u ra nce

2 . C o m p l e x i t y o f Ta s k

• Va r i a tio ns i n th e co m p l exity o f th e ta s k a f f e ct th e e xte n t to w h i ch th e l e a r n er ca n

m a s te r th e b e h av ioral ch a ng es i n th e co g n i t ive , a f f e ctive, a n d p s ych o m o to r d o main s .

• E x. p s ych o m o to r s k i ll l e a r n e d ove r a l o n g p e r i od o f ti m e a n d th e n th e p r o ce d u ral

ste p s of the ta s k ch a n g e .
3. Environmental Effects

An environment conducive to learning helps to hold the learner ’s attent ion and
stimulat e interest in learning.

4. Health Status

The amounts of energy available and the individual’s present comfor t level are
factors that signif icant ly inf luence that individual’s readiness to learn.
5. Gender

Women are generally more receptive to medical care and take fewer risks with
their health than do men

Role of caregivers

Changes are beginning to be seen in the health -seeking behavior of men and
women as a result of the increased focus of people of all sexes on healthier
lifestyles and the blending of gender roles in the home and workplace
Emotional Readiness
1. Anxiety level - Anxiety inf luences a person’s ability to per form at cognitive,
af fective, and psychom otor levels. In par ticular, it af fects patient s’ ability to
concent rate and retain information ( Kessels , 2003; Sandi & Pinelo-Nava, 2007;
Stephenson, 2006).

A moderate level of anxiety is best for success in learning and also is considered the
optimal time for teaching.

2. Suppor t system -The availability and strength of a suppor t system also inf luence
emotional readiness and are closely tied to how anxious an individual might feel.

A strong positive suppor t system can decrease anxiety, whereas the lack of one can
increase anxiety levels.
3. Motivati on -willingness to take action. A learner may be motivated to learn for
many reasons, and almost any reason to learn is a valid one. The learner who is ready
to learn shows an interest in what the nurse educator is doing by demonstrating a
willingnes s to par ticipate or to ask questions.

4. Risk-Taki ng Behavior -Taking risks is intrinsic in the activit ies people per form daily.
Indeed, many activit ies are done without thinking about the outcom e. Understanding
staff willingness to take risks helps the nurse educator understand why some learners
may be hesitant to tr y new approaches to delivering care.
5. Frame of mind - involves concern about the here and now versus the future. If
sur vival is of primar y concern, readiness to learn will be focused on the present to
meet basic human needs. According to Maslow (1970), physical needs such as food,
warmth, comfor t, and safety as well as psychosocial needs of feeling accepted and
secure must be met before someone can focus on higher order learning.

6. Developmental Stage -Each task associat ed with human developm ent produces a
peak time for readiness to learn, known as a teachable moment Unlike children, adults
can build on meaningf ul past experiences and are strongly driven to learn information
that helps them to cope better with real -lif e tasks.
Experiential Readiness

• Experiential readiness refers to the learner ’s past experiences with learning.

• The educator should assess whether previous learning experiences have

been positive or negative in overcoming problems or accomplishing new
tasks.

• Someone who has had negative experiences with learning is not likely to be
motivated or willing to take a risk to change behavior or acquire new
behaviors.
1. Level of Aspiration-The extent to which someone is driven to
achieve is related to the type of short - and long-term goals
established—not by the educator but by the learner.

2. Past Coping Mechanisms-Educators must explore the coping

mechanisms that learners have been using to understand how they
have dealt with previous problems. Once these mechanisms are
identified, the educator needs to determine whether past coping
strategies have been effective and, if so, whether they work well in the
present learning situation.
3. Cultural Background -The educator ’s knowledge about other cultures and
sensitivity to behavioral differences between cultures are important so that
the educator can avoid teaching in opposition to cultural beliefs. Building on
the learner ’s knowledge base or belief system (unless it is dangerous to well -
being), rather than attempting to change it or claim it is wrong, encourages
rather than dampens readiness to learn.

Language is also a part of culture and may prove to be a significant obstacle

to learning if the educator and the learner do not speak the same language
fluently.
4. Locus of Control -readiness to learn is prompted by internal or external
stimuli

When patients are internally motivated to learn, they have what is called an
internal locus of control

If patients have an external locus of control —that is, they are externally
motivated—then someone other than themselves must encourage the learner
to want to know something
Knowledge Readiness
1 . P r esen t k n o w l e dg e b a s e -Ho w m u ch s o m e o n e a l r e a dy k n o w s a b o u t a s p e ci f ic s u b j e ct o r
how p r of icient tha t p e r s o n i s a t p e r f o r ming a ta s k .

2 . C o g n i t i ve Ab i l i t y - Th e e xte n t to w h i ch i n f o rma tion ca n b e p r o ce s s e d is i n d ica tive o f th e

l e a r n er ’s ca p a b ility.

3 . Le a r n i n g a n d Re a d i n g D i s a b i l i t i e s - Le ar nin g d i s a b ilities , w h i ch m ay b e a cco m p a n ied b y

l o w - le vel r e a d i n g s k i l ls , a r e n o t n e ce s s a r ily i n d i cative o f a n i n d i vidu al’s i n te llectual a bilities ,
b u t th e y d o r e q u i re e d u ca to rs to u s e s p e ci al o r i n n ova tive a p p r o a che s to i n s tr u ctio n to
s u s ta i n o r b o l s te r r e a d i n es s to l e a r n .

In d i vid u als w i th l o w l i teracy s k i lls a n d l e a r n ing d i s a b ilities b e co m e e a s i l y d i s co u ra ge d u n les s

th e e d u ca tor r e co g n ize s th e i r s p e ci a l n e e d s a n d s e e k s way s to h e l p th e m a cco m m o d ate o r
ove r co m e th e i r p r o b l em s w i th e n co d in g w o rd s a n d co m p r e h en din g i n f o r ma tion
4. Learning Styles -A variety of preferred styles of learning exist, and assessing
how someone learns best and likes to learn helps the educator to select
appropriate teaching approaches. Knowing the teaching methods and materials
with which a learner is most comfor table or, conversely, those that the learner
does not tolerate well allows the educator to tailor teaching to meet the needs of
individuals with different styles of learning, thereby increasing their readiness to
learn.

3 mechanisms to determine learning style:

1. observation

2. interviews

3. administration of learning style instruments

Learning style model and instruments

Before using any learning style instrument, it is

important to determine the reliability and validity of the tool
and to realize that a totally inclusive instrument that
measures all domains of learning—cognitive, affective, and
psychomotor—does not exist.
Right-Brain /Left-Brain and Whole-Brain Thinking
• Roger Sperry-established that, in many ways, the brain operates as two
brains (Herrmann, 1988; Sperry, 1977), with each hemisphere having
separate and complementary functions.

• The lef t hemisphere of the brain was found to be the vocal and analytical
side, which is used for verbalization and for reality-based and logical
thinking.

• The right hemisphere was found to be the emotional, visual –spatial, and
nonverbal side, with thinking processes that are intuitive, subjective,
relational, holistic, and time free.
• According to Sperry ’s theory, brain hemisphericity is linked to cognitive
learning style or the way individuals perceive and gather information to
solve problems, complete assigned tasks, relate to others, and meet the
daily challenges of life.

• Most individuals have a dominant side of the brain. Gondringer (1989)

repor ts that most learners have lef t-brain dominance and that only
approximately 30% have right-brain dominance.
Instruments to Measure Right-Brain /Left-Brain and
Whole-Brain Thinking

1. Brain preference indicator (BPI)

2. Herrmann Brain Dominance Instrument

(HBDI)
Dunn and Dunn Learning Styles
• Rita Dunn and Kenneth Dunn

• user-friendly model that would assist educators in identifying

characteristics that allow individuals to learn in different ways (Dunn
& Dunn, 1978)

• Their model includes motivational factors, social interaction patterns,

and physiological and environmental elements. These researchers
identified five basic stimuli that affect a person’s ability to learn.
1. Environm ental elements (such as sound, light, temperature, and design), which are
biological in nature

2. Emotional elements (such as motivation, persistence, responsibility, and structure),

which are developmental and emerge over time as an outgrowt h of experiences that
have happened at home, school, play, or work.

3. Sociological patterns (such as the desire to work alone or in groups, or a

combinat ion of these two approaches), which are thought to be socioculturally based

4. Physical elements (such as perceptual strength, intake, time of day, and mobility),
which are also biological in nature and relate to the way learners function physically

5. Psychological elements (such as the way learners process and react to information),
which are also biological in nature
End
Thank you!